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The Health Care Thread: Ask a Professional


shk75

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So I have thought about starting this thread for a while but I kind of held off. I have recently seen a lot of debate about health care reform and a lot of confusion and recently a couple of members have asked that I start a thread on this topic.

As for my qualifications, I hold a BA in Political Science and Economics, a Masters in Health Care Policy, and am pursuing my Doctorate in comparative health care systems. I have worked for the WHO and KFF and currently serve as a consultant.

I would like to openly declare my bias which is that I am in favor of a universal system whether it be single or multi-payer. So if you feel like you have doubts/questions/concerns on the health care reform bill or any other related topics I will try to give you as unbiased/factual response as possible. If I do not know the answer hopefully there are some other professionals who feel they can respond. I have just one request: let's keep this civil and factual.

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Why??

Well it is based on an ethical belief that all people have a basic right to health care. I do not believe any person should go bankrupt or die simply because they cannot afford or do not have health insurance. We are the only OECD nation that allows our citizens to die and go bankrupt because of a lack of access to medical care. It has been proven that our system does not work for these populations and universal care is the only system that has been proven to work. That is why when nations make the leap from developing to developed they implement universal care (i.e. South Korea, Taiwan, Colombia).

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I'd be interested in some actual data:

(1) What are the cost projections for coverage for the average family under private insurance? Premiums and typical out of pocket costs per year.

(2) Of those premiums paid to insurance companies, how are they spent? Payments to healthcare providers, operating costs for the insurer, monies paid to shareholders or retained by the company?

(3) Where are the sources of high cost in our healthcare system and how are they different to comparable western countries? i.e. average expenditure on pharmaceuticals or preventative care by decade of life. Do we spend here more in later years or where are the variances?

(4) Do the cost differences arise between much more expensive diagnosis, more prescription of long term drugs (related to obesity, high cholesterol, or whatever), or very high end of life care?

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Why 81$ for a tylonol

or 4$ for a single wetwipe

is trying to pass that on to others not making 97% default to not able to afford a basic service even?

Question2:

Which is worse:

Dying in a country that has unicare but wont provide xyd service due to cost vs life years.

Dying in a counry that has no unicare but can't afford said same expensive service?

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I'd be interested in some actual data:

(1) What are the cost projections for coverage for the average family under private insurance? Premiums and typical out of pocket costs per year.

Since 2005 average premiums have increased by 47% while average salaries have only increased by 18%, projections for the future have premiums continuing to increase but at a slower rate in relation to salaries. in 2010 the average family paid $4,000 in premiums for health insurance. In terms of out of pocket costs I am not familiar with the specifics but I have seen percentages range from 5-15% of salary

(2) Of those premiums paid to insurance companies, how are they spent? Payments to healthcare providers, operating costs for the insurer, monies paid to shareholders or retained by the company?

On average 80% of premiums are spend on medical operations and 20% are spent on administrative, overhead, and operating costs like marketing

(3) Where are the sources of high cost in our healthcare system and how are they different to comparable western countries? i.e. average expenditure on pharmaceuticals or preventative care by decade of life. Do we spend here more in later years or where are the variances?

The sources of high costs are administrative, about 3-4 times other western nations, intrusive medical operations, about 1.5 times western nations, pharmaceuticals, about equal to other western nations. We spend more on emergency care, end of life care, and high tech care

(4) Do the cost differences arise between much more expensive diagnosis, more prescription of long term drugs (related to obesity, high cholesterol, or whatever), or very high end of life care?

the costs differences between our system and other nations are based on two main issues, much higher administrative costs, and lower preventative care which lead to higher costs for emergency and highly intrusive operations as well as a much higher rate of technology like MRI and catscans (although not nearly as high as Japan). Also our costs are much higher for similar procedures up to 4 times as high.

---------- Post added January-8th-2011 at 02:27 PM ----------

Why 81$ for a tylonol

or 4$ for a single wetwipe

is trying to pass that on to others not making 97% default to not able to afford a basic service even?

Question2:

Which is worse:

Dying in a country that has unicare but wont provide xyd service due to cost vs life years.

Dying in a counry that has no unicare but can't afford said same expensive service?

In terms of high costs for tylenol I assume you mean why a hospital would charge $81 for tylenol? This is because hospitals try to recoup losses from uninsured/underinsured patients as well as low medicare/medicaid rates by increasing the costs of basic items like tylenol, baby wipes, or other items.

Your second question is a question many debate daily especially the organization NICE in the British National Health Service. NICE is charged with deciding what care will be paid for by the system and what care will be excluded. In order to do this they use a formula created by the WHO called the DALY (disability adjusted life years). I won't get into the specifics of the formula but it weighs the cost benefits of operations. There is a misconception that many people in Europe and Canada die because the system will not pay for their care. This is simply untrue and many many more people die in the US because they cannot pay for care. In my opinion neither is acceptable but unfortunately resources are limited by definition and I would rather live in a system with universal care then one like ours.

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Well it is based on an ethical belief that all people have a basic right to health care. .

I agree with that in that I feel a function of government should be to provide basic health services.

It is the meaning of basic where I fear we differ.

What would you think of a nationwide expanded clinic system,with private ins and charity hospitals covering anything beyond the clinics level of service?

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" in 2010 the average family paid $4,000 in premiums for health insurance. "

This $4k seems remarkably low. Does this include monies paid by employers? Is this averaged across families who do and don't have coverage?

No this does not include employers contribution and it is not averages across families without coverage it is the average contribution by employees. The average employer contribution jumped 20% from $8,200 to $9,800.

---------- Post added January-8th-2011 at 02:44 PM ----------

I agree with that in that I feel a function of government should be to provide basic health services.

It is the meaning of basic where I fear we differ.

What would you think of a nationwide expanded clinic system,with private ins and charity hospitals covering anything beyond the clinics level of service?

The problem with this proposal is while it would increase preventative care and basic health coverage, it would not provide more complicated operations or interventions and would not do anything for pharmaceutical costs. %10 of patients costs are pharmaceutical so this is very significant and in fact many Americans have died because they have not been able to afford their medications. The other problem with the clinic/hospital idea is that it can create medical island where vast populations, usually rural, do not have access to these services.

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I actually spent all semester writing a speech on universal healthcare.

Projected costs for UHC in this country are around 1.5 trillion, and that's fox news saying that so I'm guessing thats the high end, while the total amount of money spent on HC last year was 2.3 trillion.

Around 75% of those costs were used in treating preventable chronic illnesses.

The per capita cost is $7300 which is 2.5 times the average of other 1st world countries with UHC.

16% of our GDP went to HC which is about 4% more than the next country.

Our HC system is EMBARRASSING, 50 million people are currently uninsured. HOW THE **** IS THAT OK?

If UHC was implemented only to basic clinic services like diagnostic tests, and routine check ups then we would drastically lower the cost of HC in this country per person as well as greatly improving overall health by allowing everybody to see their doctor on a regular basis. If yearly checkups were free then patients would be going far more often which has great importance because the only way to prevent those chronic illnesses is by monitoring health closely to see if there are any problems around the corner.

Listen, if you believe in the declaration of independence then you believe in UHC.

"All men are created equal and are endowed by their creator with certain inalienable rights, that among these are the right to LIFE..."

Right there. No one should have to die because they can't afford to live. It's what I hate most about this country.

Why the **** should HC be run for profit? Insurances make money by denying coverage. Thats ****ing disgraceful. There is such a flagrant conflict of interest that affects peoples' lives daily. How can anyone think this is ok.

BTW, I am a nationally licensed pharmacy technician so I know how bull**** this current system is. Your insurance companies essentially have all the power because we are very reliant on them to cover most of the costs but what if they decide that they don't want to pay for it? Well they ****ing do that all the time. They force the patient to choose another medication, one that is on their drug list or they make the doctor call them to get an approval which takes 1-3 days most of the time. But why should they care, they don't see what I see. They don't see the despair and the anxiety in a patient who is faced with the reality of not being able to afford a medication that is very necessary for their health.

Especially medicaid patients. One guy came in with a prescription for Prevpac for 14 pills. The insurance didn't cover it. The cost ---- $404. Prevpac combines two antibiotics and an acid reflux med. If his condition goes untreated it could potentially be fatal.

The pharmacist of course knew this and made the decision to sell the 3 meds individually which would cost about 350 dollars less. The patient couldn't even pay that because he was completely reliant on medicaid.

It was one of the more difficult experiences i have had since working as a tech. A desperate patient looking you in the eye and asking you what can you do? There was nothing we could do and I had to tell him. I'm still furious and embarrassed about that experience. The most powerful nation in the world and we don't even care enough to provide these essential basic services that everyone should be priveleged to.

To any of you who support this current HC system, you support murder in my eyes. I don't care if you think that claim is outrageous. It's the ****ing truth.

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I actually spent all semester writing a speech on universal healthcare.

Projected costs for UHC in this country are around 1.5 trillion, and that's fox news saying that so I'm guessing thats the high end, while the total amount of money spent on HC last year was 2.3 trillion.

Around 75% of those costs were used in treating preventable chronic illnesses.

The per capita cost is $7300 which is 2.5 times the average of other 1st world countries with UHC.

16% of our GDP went to HC which is about 4% more than the next country.

Our HC system is EMBARRASSING, 50 million people are currently uninsured. HOW THE **** IS THAT OK?

If UHC was implemented only to basic clinic services like diagnostic tests, and routine check ups then we would drastically lower the cost of HC in this country per person as well as greatly improving overall health by allowing everybody to see their doctor on a regular basis. If yearly checkups were free then patients would be going far more often which has great importance because the only way to prevent those chronic illnesses is by monitoring health closely to see if there are any problems around the corner.

Listen, if you believe in the declaration of independence then you believe in UHC.

"All men are created equal and are endowed by their creator with certain inalienable rights, that among these are the right to LIFE..."

Right there. No one should have to die because they can't afford to live. It's what I hate most about this country.

Why the **** should HC be run for profit? Insurances make money by denying coverage. Thats ****ing disgraceful. There is such a flagrant conflict of interest that affects peoples' lives daily. How can anyone think this is ok.

BTW, I am a nationally licensed pharmacy technician so I know how bull**** this current system is. Your insurance companies essentially have all the power because we are very reliant on them to cover most of the costs but what if they decide that they don't want to pay for it? Well they ****ing do that all the time. They force the patient to choose another medication, one that is on their drug list or they make the doctor call them to get an approval which takes 1-3 days most of the time. But why should they care, they don't see what I see. They don't see the despair and the anxiety in a patient who is faced with the reality of not being able to afford a medication that is very necessary for their health.

Especially medicaid patients. One guy came in with a prescription for Prevpac for 14 pills. The insurance didn't cover it. The cost ---- $404. Prevpac combines two antibiotics and an acid reflux med. If his condition goes untreated it could potentially be fatal.

The pharmacist of course knew this and made the decision to sell the 3 meds individually which would cost about 350 dollars less. The patient couldn't even pay that because he was completely reliant on medicaid.

It was one of the more difficult experiences i have had since working as a tech. A desperate patient looking you in the eye and asking you what can you do? There was nothing we could do and I had to tell him. I'm still furious and embarrassed about that experience. The most powerful nation in the world and we don't even care enough to provide these essential basic services that everyone should be priveleged to.

To any of you who support this current HC system, you support murder in my eyes. I don't care if you think that claim is outrageous. It's the ****ing truth.

While I appreciate your zeal and your facts are indeed correct, I would kindly ask you to prevent from using statements like the last line. I am trying to make this thread as civil as possible since there are countless other threads on this board that discuss the topic and end up with people just insulting everyone else. Also I have interviewed many pharmacy techs during my research and they share your sentiments so I know it is an emotional topic.

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No this does not include employers contribution and it is not averages across families without coverage it is the average contribution by employees. The average employer contribution jumped 20% from $8,200 to $9,800.

So I asked for the cost for the average family and you provided a number that was less than a third of the cost of the coverage. :ols:

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So I asked for the cost for the average family and you provided a number that was less than a third of the cost of the coverage. :ols:

No the cost for the average family is $4,000 that is what the average family pays. The employer is not the average family that is the employee. Now if you would have asked what is the average cost of a health premium for both employees and employers than the total would have been $13,800. I do not understand what your contention is.

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Excellent thread. The only gripe I have is where the heck were you when the real bullets were flying during the runup to the congressional vote on the bill? :)

Like you I'm involved in healthcare policy, though for me it's a sideline. Perhaps I'm different from you in that I was originally on the other side of the issue until I went back to school to get my MPH. Seeing the data, the cold, hard facts actually changed my mind on this issue. My motivations are more practical than yours but I most certainly agree with the need for a massive overhaul of the system...even after the improvements brought about by "Obamacare".

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Excellent thread. The only gripe I have is where the heck were you when the real bullets were flying during the runup to the congressional vote on the bill? :)

Like you I'm involved in healthcare policy, though for me it's a sideline. Perhaps I'm different from you in that I was originally on the other side of the issue until I went back to school to get my MPH. Seeing the data, the cold, hard facts actually changed my mind on this issue. My motivations are more practical than yours but I most certainly agree with the need for a massive overhaul of the system...even after the improvements brought about by "Obamacare".

LOL thanks I was actually doing research for my thesis in Western Europe. Part of that involved getting care in many of the nations and evaluating their systems. Every time I would talk about my research they were all shocked by our system and when I would tell them that the reform would still leave 23 million uninsured they were even more baffled.

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I do not understand what your contention is.

My point is that assuming that the average family has employment that covers two thirds of the cost is completely misleading when stating costs of private healthcare if the desire is to compare with other nations. The number of families getting employment-based assistance on healthcare costs is below 60% and dropping. In many industries it is far, far below 50%.

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The problem in the US, as to other "developed" countries isn't he lack of preventive care as you so state. It's the lack of proper diet and nutrition, obesity, and the propensity to prescribe medicines to cure the ill's of a fat country.

This problem wont be corrected by a universal system.

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To any of you who support this current HC system, you support murder in my eyes. I don't care if you think that claim is outrageous. It's the ****ing truth.

So if you believe in abortion then you are a murderer and hate the Constitution(LIFE) also. right?

There is a skosh more to it.

back on topic:

If we are paying 80dollars for a tylenol and wipes for people that dont have insurance.

Does that mean hospitals are taking people without insurance?Are they only patching them up and getting them out?

With Unicare taking this part on (thus Hospital fees will plummet) and we can pay for it ourselves again?

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The problem in the US, as to other "developed" countries isn't he lack of preventive care as you so state. It's the lack of proper diet and nutrition, obesity, and the propensity to prescribe medicines to cure the ill's of a fat country.

This problem wont be corrected by a universal system.

This simply is not factual. We are not the only nation that has seen obesity rise. It is a global phenomenon and many nations are seeing higher rates of obesity complicated diseases than ever. For example in Britain this rate has gone from 1 in 10 to 1 in 7 in just 15 years. However, Britain has a much higher survival rate for diabetes because they have a system that guarantees care and focuses on preventative measures. For chronic conditions like diabetes, this is where the US system really fails and unfortunately obesity is linked to many other chronic conditions like heart disease, kidney failure, and liver disease. In order to combat this epidemic you need two things

1. a system that guarantees care for all and focuses on preventative measures so that expensive and deadly complications are avoided

2. a vast public health campaign like that seen during the 50s and 60s to try to curb smoking

---------- Post added January-8th-2011 at 06:36 PM ----------

So if you believe in abortion then you are a murderer and hate the Constitution(LIFE) also. right?

There is a skosh more to it.

back on topic:

If we are paying 80dollars for a tylenol and wipes for people that dont have insurance.

Does that mean hospitals are taking people without insurance?Are they only patching them up and getting them out?

With Unicare taking this part on (thus Hospital fees will plummet) and we can pay for it ourselves again?

Correct in emergency situations hospitals are required to treat patients. Many hospitals do not collect up to 20% of their costs and thus must recuperate these expenses through tactics like raising the price of basic materials. Also hospitals have different prices depending on the patients. These are what we call fee schedules and the same procedure may hove 5 different prices depending on if the person has insurance, medicare, medicaid, SCHIP, a cadillac plan. Those that have no insurance at all are charge the highest rates of all. Hospital fees would plummet under universal care which is a big reason why Universal care cost projections are consistently lower than our current system.

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This simply is not factual. We are not the only nation that has seen obesity rise. It is a global phenomenon and many nations are seeing higher rates of obesity complicated diseases than ever. For example in Britain this rate has gone from 1 in 10 to 1 in 7 in just 15 years. However, Britain has a much higher survival rate for diabetes because they have a system that guarantees care and focuses on preventative measures. For chronic conditions like diabetes, this is where the US system really fails and unfortunately obesity is linked to many other chronic conditions like heart disease, kidney failure, and liver disease. In order to combat this epidemic you need two things

1. a system that guarantees care for all and focuses on preventative measures so that expensive and deadly complications are avoided

2. a vast public health campaign like that seen during the 50s and 60s to try to curb smoking

What does Britain's rise in obesity and diabetes have to do with anything? Fact is they have a universal system, so it's not helping them. Not sure how that helps your argument.

Regardless, America is the ONLY country where our population eats more prepared foods from a box than any country in the world. There is cheap fast food available to anyone, minutes from their home.

Our health problems stem from our appetite for garbage.

All that said, I would like to retire early, so I certainly wouldn't mind a free ride outside of Medicare. But to think universal care would improve the health of our nation is naive.

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What does Britain's rise in obesity and diabetes have to do with anything? Fact is they have a universal system, so it's not helping them. Not sure how that helps your argument.

Regardless, America is the ONLY country where our population eats more prepared foods from a box than any country in the world. There is cheap fast food available to anyone, minutes from their home.

Our health problems stem from our appetite for garbage.

All that said, I would like to retire early, so I certainly wouldn't mind a free ride outside of Medicare. But to think universal care would improve the health of our nation is naive.

Because you state that a universal system would do nothing for us since we have such a high obesity rate. However, a universal care would improve the health of those with obesity related problems so that is why Britain is a good example. Also before we had a boom in obesity we still lagged behind other nations with universal systems.

Let me accept your argument for a second. I agree with you that obesity is the biggest health problem facing the US. Now that we know it is the problem what do you do? Do you not expand access to preventative care so that health outcomes are improved? Or do you make sure that they are all insured so that those who do face obesity related health issues can receive care before it becomes to late. If we are strictly talking about economics you would insure this population because the monetary cost to insure them would be lower than the cost to treat them when their health is highly deteriorated.

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Because you state that a universal system would do nothing for us since we have such a high obesity rate. However, a universal care would improve the health of those with obesity related problems so that is why Britain is a good example. Also before we had a boom in obesity we still lagged behind other nations with universal systems.

Let me accept your argument for a second. I agree with you that obesity is the biggest health problem facing the US. Now that we know it is the problem what do you do? Do you not expand access to preventative care so that health outcomes are improved? Or do you make sure that they are all insured so that those who do face obesity related health issues can receive care before it becomes to late. If we are strictly talking about economics you would insure this population because the monetary cost to insure them would be lower than the cost to treat them when their health is highly deteriorated.

It's a great question, one which I don't have an answer. I think we are doomed in either scenario. Here are my issues which think lead to major problems under either plan.

Doctors themselves today do not agree on nutrition. Many are ignorant to healthy eating, and rather than push a healthy lifestyle they pedal prescription medication. We are an over prescribed country. I don't know how to fix that.

We are a highly litigious society. This is a major contributor to driving health care costs through the roof in my opinion. I am not sure that is corrected in a universal plan.

Government run health care is really scary to me. I can tell you some horror stories about medicare, hopefully you already know the issues with that system. How can I want my government to invest in universal health care, when the one they have for seniors is a big giant train wreck. Good doctors are now refusing to take medicare patients.

So while universal care sounds like a silver bullet, I think with the way things are going diet wise in America, it's just going to mask an underlying health epidemic.

I do wish you luck in your endeavors. You have a long tough battle in front of you.

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The sources of actual cost are of real interest to me. What precise percentage is due to:

(1) pharmaceuticals

(2) use (and over use) of technology

Many co-workers who had terrible diets, were lazy regarding exercise, and were seriously overweight, were trying to mitigate the bad health consequences with large quantities of pharmaceuticals. This behavior should not be covered under health insurance. I find it strange that our insurance companies place restrictions on what our doctors can initially prescribe on the very rare situations we are ill, and yet something like 60% of Americans are over medicated.

Why don't health insurers offer products where they don't cover conditions associated with obesity, smoking or alcohol/drug abuse?

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It's a great question, one which I don't have an answer. I think we are doomed in either scenario. Here are my issues which think lead to major problems under either plan.

Doctors themselves today do not agree on nutrition. Many are ignorant to healthy eating, and rather than push a healthy lifestyle they pedal prescription medication. We are an over prescribed country. I don't know how to fix that.

We are a highly litigious society. This is a major contributor to driving health care costs through the roof in my opinion. I am not sure that is corrected in a universal plan.

Government run health care is really scary to me. I can tell you some horror stories about medicare, hopefully you already know the issues with that system. How can I want my government to invest in universal health care, when the one they have for seniors is a big giant train wreck. Good doctors are now refusing to take medicare patients.

So while universal care sounds like a silver bullet, I think with the way things are going diet wise in America, it's just going to mask an underlying health epidemic.

I do wish you luck in your endeavors. You have a long tough battle in front of you.

Thank you for this post! I love this because these are very common misconceptions and I do not blame you because health care is a very complicated topic and sometimes even I am lost lol.

As to being an over prescribed nation: This maybe true and I am not a nutritionist but our rates of drug use are considered too high by many physicians. However, they are far from highest in the world with countries like France, Japan, and Britain leading the way.

Medical malpractice is seen as a major problem but is in fact not significant at all when it comes to health care costs and has been estimated at .1 of 1% of all costs. Many say we need to make it harder to sue doctors and place caps on awards, but take Texas as an example which has passed maybe the strictest medical malpractice law in order to discourage lawsuits but have seen their costs skyrocket at a higher rate than the national average

Government run health care does not have to be run by the government. It can be a multi-payer system, what we refer to as a Bismarck system. This means health insurance companies remain private, hospitals remain private, doctors remain private, the only thing that changes is they have to abide by one and only one federal fee schedule.

---------- Post added January-8th-2011 at 07:10 PM ----------

The sources of actual cost are of real interest to me. What precise percentage is due to:

(1) pharmaceuticals

(2) use (and over use) of technology

Many co-workers who had terrible diets, were lazy regarding exercise, and were seriously overweight, were trying to mitigate the bad health consequences with large quantities of pharmaceuticals. This behavior should not be covered under health insurance. I find it strange that our insurance companies place restrictions on what our doctors can initially prescribe on the very rare situations we are ill, and yet something like 60% of Americans are over medicated.

Why don't health insurers offer products where they don't cover conditions associated with obesity, smoking or alcohol/drug abuse?

1. 10-11%

2. It is difficult to quantify that number but all agree that it is a main driver of increased costs and overuse is a serious problem

here is a good breakdown of our costs

hc%20cost%20exp.jpg?w=475&h=429&as=1

Well many do not cover these costs since they list them as preexisting conditions. However, it is my belief that it is vital they be covered or else, as I stated earlier, costs will rise even more dramatically.

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